Surgical management of upgaze diplopia in patients after posttraumatic orbital floor reconstruction

The most common complication of otherwise successful reconstructive surgery of a fractured orbital floor is persistent diplopia. For patients with troublesome double vision in upgaze, a reasonable solution is offered by strabismus surgery. The aim of our study is to examine the results of extraocular muscle surgery in cases of diplopia that persisted in upgaze after posttraumatic orbital floor reconstruction.

In this study we present a retrospective series of 24 patients with troublesome vertical diplopia in upgaze. In all cases, the surgery consisted of a posterior fixation suture placement on the contralateral superior rectus muscle with or without its recession. Full orthoptic examination was conducted before and 3 months after the surgery.

Postoperatively 19 patients (79%) were diplopia free and 6 (21%) had vertical diplopia in extreme upgaze. The field of binocular single vision improved threefold. None of the patients reported diplopia in the primary position or in any position other than upgaze.

Vertical incomitant strabismus and diplopia in upgaze persisting after orbital reconstructive surgery may be corrected surgically. Contralateral posterior fixation of the superior rectus muscle, with or without its recession, appears to be an effective procedure for use in these patients.